Surgical adhesive applicator

ABSTRACT

An adhesive applicator for applying medical adhesives, particularly cyanoacrylates, to incisions such as those made during minimally invasive surgery. The applicator employs a pipette tip or similar narrow flow restrictor tip to close the incision and a body of foam to seal the incision. Methods of using the applicator are also disclosed.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims benefit under 35 U.S.C. §119 (e) of U.S.Provisional Application Ser. No. 60/817,762, filed 30 Jun. 2006, whichis hereby incorporated by reference in its entirety.

TECHNICAL FIELD

The present invention relates to applicators for surgical adhesives.

BACKGROUND OF THE INVENTION

Minimally invasive surgery, such as laparoscopic surgery, has become thesurgical technique of choice in many situations. In general, minimallyinvasive surgery is accomplished using small incisions. Minimallyinvasive surgery often involves the use of specialized equipment andtechniques, such as miniature cameras with microscopes, tiny fiber-opticflashlights and high definition monitors. Benefits observed from the useof minimally invasive surgery include minimized pain, faster recovery,and elimination of potential complications associated with traditionalsurgical techniques.

Minimally invasive surgical procedures can be used in a number ofsituations including cardiovascular surgery, colon and rectal surgery,gastroenterologic, gynecological surgery, neurosurgery, orthopedicsurgery, otorhinolaryngology (ear, nose and throat) surgery, thoracicsurgery, urological surgery, and vascular surgery.

A particular type of minimally invasive surgery is laparoscopic surgery.Laparoscopic surgery involves the performance of surgical procedureswith the assistance of a video camera and several thin instruments. Theuse of the camera allows the surgeon to sees images of the patient'sbody during surgery. During the surgical procedure, small incisions ofup to half an inch are made and plastic tubes called ports are placedthrough these incisions. The camera and the instruments are thenintroduced through the ports which allow access to the inside of thepatient. Laparoscopic surgery is used to perform numerous surgeries suchas adrenalectomies, appendectomies, treatment for bowel tumors, lymphnode biopsys, gallbladder surgery, hernia repair, treatment for stomachtumors, splenectomies, bariatric surgery, removal of fibroids, removalof benign ovarian cysts, treatment of pelvic endometriosis,fundoplication for gastroesophageal reflux disease (GERD), myotomy forachalasia, nephrectomies, partial nephrectomies, donor nephrectomies,pyeloplasties, and opening of cysts.

The small incisions made during the minimally invasive surgeries can beclosed by traditional techniques, such as the introduction of sutures orstaples to close the incision wounds. More recently, the use of surgicaladhesives has gained favor in closing the incisions. These adhesives areliquid in nature and, upon contact with surface skin proteins andmoisture, will polymerize and the resulting polymer bonds strongly tothe skin. When applied over apposed skin sections of a wound, theadhesives polymerize and join these apposed skin sections to result inclosure of the wound. The adhesives can be formulated to includeantimicrobial agents to aid in healing of the wound. The adhesive neednot be removed from the wound because it will naturally fall away fromthe wound as the skin renews itself.

Many different applicators for adhesives have been developed. However,the majority of these applicators do not address the need for aversatile applicator capable of effectively closing and sealing a wound.U.S. Pat. No. 7,094,250, commonly assigned to the assignee of theinstant application and incorporated herein by reference, describes anapplicator capable of effectively closing, sealing, and dressing a woundusing medical adhesive. The present application describes an improvementto the applicator described in this publication.

SUMMARY OF THE INVENTION

This invention provides for applicators suitable for use in applicationof medical adhesive to incisions and methods of using the applicators.

One aspect of the invention provides for an applicator for controllablyreleasing and applying a surgical adhesive to an incision. In apreferred embodiment, the applicator comprises a receiver having adeformable cylindrical body. The body has a deformable cylindrical walland a cylinder-closing first end and an open second end. The internaldimensions of the receiver are set to accommodate and receive a sealedampoule of surgical adhesive. The ampoule is formed of a frangiblematerial, which when fractured, releases the surgical adhesive. Thereceiver's second open end is cylindrical with a series ofcircumferential sealing ribs present on the outer surface of the secondopen end. The applicator further comprises a blunt cylindrical body of asurgical adhesive-permeable foam inserted into the open second end ofthe receiver. The body of foam serves to absorb and transmit adhesivereleased from the ampoule. The applicator further comprises acylindrical collar having an open first end and an open second end. Thefirst end of the collar has an internal diameter selected to sealablyengage the circumferential sealing ribs and the collar encloses the bodyof foam material. The second end of the collar has an internal diameterselected to provide a narrowed pathway for the released adhesive to passwhen the collar is sealed to the second end of the receiver.

In a preferred embodiment, the applicator additionally comprises alatching slot in the outer surface of the second end of the receiver.The latching slot is located adjacent to the circumferential sealingribs but is between the circumferential sealing ribs and the first end.The collar has an internally-projecting locking key which fits into thelocking slot and locks the collar onto the receiver when the collar isrotated on a common axis between the collar and the receiver. In otherpreferred embodiments, the applicator additionally comprises a flowrestrictor, such as a pipette tip, frictionally attached to the secondend of the collar through which surgical adhesive can pass.

In some embodiments, the applicator additionally comprises at least onepressure barb positioned to apply an ampoule-fracturing force to thesealed ampoule. In some embodiments, the applicator comprises at leastone pressure pad positioned to apply an adhesive-expressing pressure tothe fractured ampoule.

In further preferred embodiments, the applicator additionally comprisesa pair of wings, each having an inside and an outside end with theinside end affixed to the receiver at a position adjacent to the openend with the two wings being positioned diametrically across thecylindrical body, with the outside end of the wings being splayed outaway from the cylindrical wall but being movable toward the cylindricalwall when a user applies opposing-finger pressure to the outside ends.Each of the wings has a pressure barb facing toward the cylindricalwall. The pressure barb bears upon the cylindrical wall and is capableof applying a compressing force to the cylindrical wall which distortsthe cylindrical wall of the cylindrical body. When so distorted, thecylindrical wall applies a fracturing force to an ampoule accommodatedand received within the receiver. The fracturing force releases surgicaladhesive contained within the ampoule. Preferably, each of the wingsadditionally comprises a pressure pad facing toward the cylindricalwall. The pressure pad bears upon the cylindrical wall and is capable ofapplying an adhesive-expressing compressing force to the cylindricalwall. This compressing force distorts the cylindrical wall of thecylindrical body and thus applies an adhesive expressing force to theampoule. The adhesive-expressing force expressing force expresses thesurgical adhesive contained within the ampoule out of the applicator.

In yet another preferred embodiment, the applicator comprises a receiverhaving a deformable cylindrical body. The body has a deformablecylindrical wall and a cylinder-closing first end and an open secondend. The internal dimensions of the receiver are set to accommodate andreceive a sealed ampoule of surgical adhesive. The ampoule is formed ofa frangible material. The second open end is cylindrical with a seriesof circumferential sealing ribs present on the outer surface of thesecond open end and a latching slot in the outer surface of the secondend. The latching slot is located adjacent to the circumferentialsealing ribs but is between the circumferential sealing ribs and thefirst end.

In one embodiment, the first end of the cylindrical collar as definedabove, has an internal diameter selected to sealably engage thecircumferential sealing ribs and has an internally-projecting lockingkey which fits into the locking slot and locks the collar onto thereceiver when the collar is rotated on a common axis between the collarand the receiver. The collar encloses the body of foam. The second endhas an internal diameter selected to provide a narrowed pathway for theadhesive to pass when the collar is sealed to the second end of thereceiver. The second end of the collar has a slightly taperedcylindrical shape sized to frictionally and sealably engage a pipettetip or similar flow-focusing nozzle. The pipette tip, when sealed to thecollar provides a sealed narrow pathway for surgical adhesive to passfrom the receiver through the pipette tip and the collar. When thepipette is removed, there is a broader pathway for the adhesive to passas a sealing layer from the receiver through the body of foam to theincision.

Another aspect of the invention provides for a method of closing andsealing an incision with an adhesive applicator as described above witha sealed ampoule of surgical adhesive contained in the receiver and thecollar and pipette tip in place. A squeezing-together pressure isapplied to the wings to produce a compressing force to the cylindricalwall. The compressing force distorts the cylindrical wall of thecylindrical body and applies a fracturing force to the ampoule. Thefracturing force releases the surgical adhesive contained within theampoule. Further pressure can be applied to the wings to cause thepressure pads to supply an adhesive-expressing force to the wall of thefractured ampoule. The expressed adhesive passes through theadhesive-permeable body of foam through the cylindrical collar andthrough the pipette tip to form the small drops of adhesive. These smalldrops are applied to the incision to “spot weld” or “suture” it closed.Next, the pipette tip is removed to provide a tip-free applicator. Theincision is then sealed by applying a line of adhesive from the tip-freeapplicator to the incision through the body of adhesive-permeable foam.

In a preferred embodiment, the incision to be closed and sealed is aincision made during laparoscopic surgery.

Preferably, the surgical adhesive to be applied by the applicatorcomprises a cyanoacrylate ester. Even more preferably, the surgicaladhesive to be applied by the applicator comprises a cyanoacrylate esterand an antimicrobial agent.

BRIEF DESCRIPTION OF THE DRAWINGS

This invention will be further described with reference being made tothe drawings in which:

FIG. 1 is a top plan view of an ampoule-fracturing receiver employed inthe applicator of this invention.

FIG. 2 is a side elevational view of the ampoule-fracturing receiverdepicted in FIG. 1.

FIG. 3 is a side cross-sectional view of the ampoule-fracturing receiverdepicted in FIGS. 1 and 2.

FIG. 4 is an expanded scale top plan view of the open end portion of theampoule-fracturing receiver employed in the applicator of this inventiontaken within the area 4-4′ shown in FIG. 1 and showing thecircumferential sealing ribs and locking key employed when this receiveris incorporated into the application of this invention.

FIG. 5 is a further expanded scale top plan view of a portion of theampoule-fracturing receiver employed in the applicator of this inventiontaken within the area 5-5′ shown in FIG. 4 and showing thecircumferential sealing ribs employed when this receiver is incorporatedinto the application of this invention.

FIG. 6 is an expanded scale side cross-sectional view of the open endportion of the ampoule-fracturing receiver employed in the applicator ofthis invention taken with in the area 6-6′ shown in FIG. 3 showing thecircumferential sealing ribs employed when this receiver is incorporatedinto the application of this invention.

FIG. 7 is an exploded top plan view of the components of the applicatorof this invention showing their relationship to the ampoule from whichthe liquid (adhesive) is released and applied by the applicator.

FIGS. 8A-8C are a series of three perspective views showing A. theapplicator of this invention being used to apply small bonding drops ofadhesive to a surgical incision, B. the applicator being partiallydisassembled to reveal a smoothing-strengthening layer applicator and C.the applicator, in its partially disassemble state, being used to applythe strengthening layer to the incision.

DESCRIPTION OF PREFERRED EMBODIMENTS

With reference to the figures, FIG. 7 shows in blown up form anapplicator 100 for controllably releasing and applying a surgicaladhesive to an incision. The use of such an applicator in thisapplication is illustrated in FIG. 8 where in FIG. 8A the applicator 100can be seen delivering a series of small drops 10 of adhesive to anincision 12 while being squeezed by fingers 14 and 16. In FIG. 8B,fingers 18 and 20 can be seen partially disassembling the applicator toconvert it to a form suitable for delivering a broader strengtheninglayer 22 of adhesive to the incision 12 as shown in FIG. 8C.

As shown in FIG. 7 and in detailed FIGS. 1 through 6, applicator 100includes a receiver 24 which a has a deformable cylindrical body 26.Body 26 has a deformable cylindrical wall 28, a cylinder-closing firstend 30 and an open second end 32. As shown most clearly in FIG. 7 theinternal dimensions of the receiver are selected to accommodate andreceive a sealed ampoule 34 of surgical adhesive. Ampoule 34 is formedof a material which can contain the medical adhesive but which is alsofrangible, that is breakable, in response to pressure applied to it.

The open second end 32 of body 26 is cylindrical. A series ofcircumferential sealing ribs 36, having a diameter Dr are present on theouter surface 38 of body 26 adjacent to the second open end 32. Theseribs provide a sealing surface to which a liquid-tight seal with collar62 can be formed. These ribs 36 are cast into the body 26 of receiver 24when it is being formed and thus are made of the same deformablematerial as body 26. Polypropylene resins, such as Basell Moplen EP548Tgive good results but, of course, other similar adhesive-compatibleresilient plastics may be used. Body 26 carries a latching slot 40 inthe outer surface 38. Latching slot 40 is located near the second end 32of body 26 adjacent to the circumferential sealing ribs 36. This slot islocated between the circumferential sealing ribs 36 and the first end30. It is also to be seen in FIG. 4 that it is located on a portion ofthe body 26 having a larger diameter than the diameter Dr of thecircumferential sealing ribs 36. In this position, the slot can play apart in attaching collar 62 to body 26 without interfering with thesealing action of circumferential sealing ribs 36. This is importantbecause of the nature of surgical adhesives. They are selected becauseof their ability to adhere to skin. Any inadvertent application of suchmaterials around a surgical site, which could be brought about byinterference with the sealing effects of the sealing ribs and subsequentleakage would thus be highly undesirable.

The receiver 26 additionally includes a pair of wings 42 and 44. Thesewings each have an inside end 46 and an outside end 48. The two insideends 46 are affixed to the receiver 24 at a position 50 adjacent to theopen end 32 with the two wings 42 and 44 being diametrically opposedacross the cylindrical body 26 as best illustrated in FIG. 1. Theoutside ends 48 of the wings 42 and 44 are splayed out away from thecylindrical wall 28 but are movable toward the cylindrical wall 28 whena user applies opposing finger pressure to the outside ends 48 as shownin FIG. 8A.

Each of the wings 42 and 44 has a pressure barb 52 and 54, respectively,projecting “inwards” toward the cylindrical wall 28 of receiver 26. Thepressure barbs 52 and 54 bear upon the cylindrical wall 28 in an areaclose to the second end 32. The distance of pressure barbs 52 and 54should be no less than 2 mm and no greater than 8 mm from the end ofsealed ampoule 34. If less than 2 mm the ampoule is very difficult tobreak, more than 8 mm and the dome end remains intact and blocks of theexit hole even though the rest of the ampoule has fractured. When theuser applies a squeezing-together pressure to the two wings as shown inFIG. 8A these barbs focus this pressure as a compressing force to thecylindrical wall 28, which compressing force distorts the cylindricalwall 28 of the cylindrical body 26 and causes this pressure to beapplied as an ampoule-fracturing/fracturing force upon an ampoule 34accommodated and received within receiver 24. This fracturing forcereleases surgical adhesive contained within ampoule 34. The wings 42 and44 additionally include pressure pads 56 and 58. These pads also apply awall-distorting force to wall 28 when the wings 42 and 44 are squeezedtogether and thus apply pressure on the now-fractured ampoule to expressadhesive out of the ampoule through the fracture as shown in FIG. 8.

The released surgical adhesive comes into contact with a bluntcylindrical body 60 of a surgical adhesive-permeable foam inserted intothe open second end 32 of receiver 24. The term “foam” is usedexpansively here and is defined to include any material, such as asponge or fibrous material, that is permeable to the surgical adhesiveand acts as a “wick” absorbing and transmitting the adhesive releasedfrom the ampoule. The blunt cylindrical body of foam 60 is held in placein receiver 24 within open end 32 by cylindrical collar 62. This collarhas an open first end 64 and an open second end 66. The first end 64 hasan internal diameter, Dc, which is selected to sealably engage thecircumferential sealing ribs (of diameter Dr) on the receiver 24 in asurgical adhesive-impermeable seal. First end 64 also carries aninternally-projecting locking key (not shown) which is sized andpositioned to fit into the locking slot 40. This key and locking slotlock the collar 62 onto the receiver 24 when the collar 62 is rotatedrelative to the receiver 24 on the common axis between the collar 62 andthe receiver 24. As shown in FIG. 8B, when the collar and receiver arerotated in the reverse direction relative to one another, the two partscan be separated. Flats or grips 68 and 70 on collar 62 facilitate theuser's rotation (and thus locking and unlocking) of the collar 62relative to receiver 24. The collar 62, when attached to receiver 24,encloses the blunt cylindrical body of foam 60. Second end 66 of collar62 has a slightly tapered cylindrical outer surface 72 shaped and sizedwith an average external diameter Dc2 which frictionally and sealablyfits into and engages the inside diameter Dt of first end 74 of a flowrestrictor such as shown as pipette tip 76. The slightly taperedcylindrical outer surface 72 can be used to apply a line of adhesivethat is smaller in width than the line of adhesive that is applied usingthe blunt cylindrical body of foam 60.

Pipette tip 76, when its first end 74 is sealably-engaged to second end66 of collar 62, provides a sealed pathway for surgical adhesive to passfrom the original ampoule 34 through receiver 24, through the bluntcylindrical body of foam 60 and collar 62 receiver and thence throughthe flow-restricting pipette tip 76 and outward through end 78 to thesurgical incision as a series of fine “spot weld dots” or a fine line ofadhesive or the like. When the collar 62 (with pipette tip 76 attached)is removed, as shown in FIG. 8B it exposes the blunt cylindrical body offoam 60. The blunt cylindrical body of foam 60 is saturated withsurgical adhesive and when exposed provides a broader pathway for theadhesive to pass from the receiver 24 to the incision 12, now as asealing-strengthening coating as shown in FIG. 8C.

Applications and Adhesives

An applicator configured as described herein can be used to close andseal any incision or small wound. The preferred application is the useof the applicator to close and seal incisions made during minimallyinvasive surgery, such as laparoscopic surgery.

The applicator can be supplied as a preassembled unit comprising theapplicator preloaded with a sealed ampoule of surgical adhesive.Alternatively, the applicator can be supplied as an applicator that doesnot contain a sealed ampoule of surgical adhesive. In this situation,the user, such as a physician, nurse, physician's aid, or clinician,assembles the applicator prior to use so that it contains an ampoule ofsurgical adhesive.

The applicator is configured for use with liquid surgical adhesivematerials. The preferable liquid surgical adhesive materials to be usedwith the application are liquids containing cyanoacrylate prepolymers.

In situ polymerization of such cyanoacrylate compositions provides foran adherent polymeric film which acts to close and seal the incision. Anantimicrobially-effective amount of an antimicrobial iodophore or thelike in the cyanoacrylate composition may provide significantenhancements in the effectiveness of the composition as well.

Since the polymeric film is naturally shed from the skin surface two tofour days following application, there is no need to effect removaladhesive following surgery, therefore avoiding the skin trauma such asthat associated with removal of surgical sutures or staples. Moreover,the addition of antimicrobial agents to the cyanoacrylate compositionresults in the gradual release of the antimicrobial from the polymerizedcyanoacrylate composition, providing antimicrobial at a level thatprovides protection for post-surgical infection.

Accordingly, the applicator can be used to close and seal an incision inthe skin, such as an incision made during laparoscopic surgery, asfollows. An applicator, as described herein, with the sealed ampoule ofsurgical adhesive contained in the receiver of the applicator, is firstused to close the incision by applying small drops of adhesive from theapplicator to the incision. The small drops of adhesive are producedfrom the applicator when the user squeezes the wings of the applicatorto produce a compressing force to the cylindrical wall. The compressingforce distorts the cylindrical wall of the cylindrical body and appliesa fracturing force to the ampoule. The fracturing force releases thesurgical adhesive contained within the ampoule and the adhesive passesthrough the adhesive-permeable foam through the cylindrical collar andthrough the flow restrictor, such as a pipette tip, to form the smalldrops of adhesive. After the incision is closed using the small drops ofadhesive released from the applicator, the user removes the collar fromthe body of the applicator, thus removing the flow restrictor from theapplicator. The removal of the collar and the flow restrictor exposesthe surgical adhesive-permeable body of foam. The user then places thebody of foam contained at the end of the applicator on the closedincision and applies a line of adhesive to seal and protect theincision.

It may be desirable in some applications to apply an additional layer ofadhesive after closing the incision but prior to sealing the incisionwith adhesive applied through the body of foam. This can be achieved byremoving the pipette tip from the applicator and applying the adhesivethrough the open end of the collar. The resulting band of adhesive isnarrower than the band that is applied using the body of foam. Afterapplying this narrower band of adhesive through the open end of thecollar, the collar is removed to expose the body of foam and anadditional line of adhesive can thus be applied.

The adhesives which are applied by the applicator of the presentinvention may preferably comprise a wide variety of cyanoacrylateadhesive formulations. It is to be understood, however, that the presentinvention is not so limited. Instead, any suitable medical (ornon-medical) adhesive can be used.

In accordance with an optional preferred aspect of the presentinvention, a cyanoacrylate adhesive formulation is used. Preferably, thecyanoacrylate composition used comprises a cyanoacrylate prepolymercomposition that can be applied as a liquid to the skin surface.Optionally, the cyanoacrylate prepolymer can include therapeutic agentssuch as analgesics, anti-inflammatory agents, antimicrobial agents, andthe like.

The cyanoacrylate composition which finds preferred application usingthe applicator of this invention comprises a cyanoacrylate ester, which,in monomeric form, is represented by formula I:

wherein R is selected from the group consisting of:

alkyl of 1 to 10 carbon atoms,

alkenyl of 2 to 10 carbon atoms,

cycloalkyl groups of from 5 to 8 carbon atoms,

phenyl,

2-ethoxyethyl,

3-methoxybutyl,

and a substituent of the formula:

wherein each R′ is independently selected from the group consisting of:hydrogen and methyl, and R″ is selected from the group consisting of:

alkyl of from 1 to 6 carbon atoms,

alkenyl of from 2 to 6 carbon atoms,

alkynyl of from 2 to 6 carbon atoms,

cycloalkyl of from 3 to 8 carbon atoms,

aralkyl selected from the group consisting of benzyl, methylbenzyl andphenylethyl,

phenyl, and

phenyl substituted with 1 to 3 substituents selected from the groupconsisting of hydroxy, chloro, bromo, nitro, alkyl of 1 to 4 carbonatoms, and alkoxy of from 1 to 4 carbon atoms.

Preferably, in the cyanoacrylate esters of formula I, R is alkyl of from2 to 10 carbon atoms and more preferably alkyl of from 2 to 8 carbonatoms. Even more preferably, R is butyl, pentyl or octyl or a mixture ofbutyl and octyl (e.g., 2-ethylhexyl) and most preferably R is n-butyl.

It is to be understood that the term “polymerizable cyanoacrylateesters” refers to polymerizable formulations comprising cyanoacrylatemonomers or polymerizable oligomers which, in their monomeric form, arepreferably compounds represented by formula I as described above.

More preferably, in formula I, R is an alkyl group of from 2 to 10carbon atoms including ethyl, n-propyl, iso-propyl, n-butyl, iso-butyl,sec-butyl, n-pentyl, iso-pentyl, n-hexyl, iso-hexyl, 2-ethylhexyl,n-heptyl, octyl, nonyl, and decyl. More preferably, R is butyl, pentylor octyl and most preferably, R is n-butyl. Mixtures of such compoundscan also be employed as disclosed by Berger, et al., U.S. Pat. No.5,998,472 which is incorporated herein by reference in its entirety.

A preferred cyanoacrylate ester for use in the invention isn-butyl-2-cyanoacrylate.

The polymerizable cyanoacrylate esters described herein rapidlypolymerize in the presence of water vapor or tissue protein, and then-butyl-cyanoacrylate bonds to mammalian skin tissue without causinghistotoxicity or cytotoxicity. Polymerization occurs at ambient skintemperature while maintaining the skin surface under suitable conditionsto allow polymerization to proceed. In general, the length of timerequired for polymerization will vary depending on factors such as theamount of adhesive composition applied, the temperature of the skin, themoisture content of the skin, the surface area of skin to which theadhesive was applied, and the like. However, polymerization is typicallycomplete within about 10 to about 60 seconds, while the skin ismaintained at ambient conditions.

Such polymerizable cyanoacrylate esters are sometimes referred to hereinas prepolymers and compositions comprising such esters are sometimesreferred to herein as prepolymer compositions.

Polymerizable cyanoacrylate esters are known in the art and aredescribed in, for example, U.S. Pat. Nos. 3,527,224; 3,591,676;3,667,472; 3,995,641; 4,035,334; and 4,650,826 the disclosures of eachare incorporated herein by reference in their entirety.

In preferred embodiments, the sealing-strengthening layer of liquidcyanoacrylate laid down by the applicator has a thickness of no morethat about 1 millimeter and yields a polymerized cyanoacrylatecomposition layer that has a thickness of no more than about 1millimeter. More preferably, the polymer layer and the liquid layer havea uniform thickness of from about 2 to about 500 μm. Still morepreferably, the layers have a thickness of from about 20 to about 100μm.

Optionally, the cyanoacrylate composition applied by the presentapplicator can include a “biocompatible plasticizer.” As used herein,the term “biocompatible plasticizer” refers to any material which issoluble or dispersible in the cyanoacrylate composition, which increasesthe flexibility of the resulting polymeric film coating on the skinsurface, and which, in the amounts employed, is compatible with the skinas measured by the lack of moderate to severe skin irritation. Suitableplasticizers are well known in the art and include those disclosed inU.S. Pat. Nos. 2,784,127 and 4,444,933 the disclosures of both of whichare incorporated herein by reference in their entirety. Specificplasticizers include, by way of example only, acetyl tri-n-butylcitrate, acetyl trihexyl citrate butyl benzyl phthalate, dibutylphthalate, dioctylphthalate, n-butyryl tri-n-hexyl citrate, diethyleneglycol dibenzoate and the like. The particular biocompatible plasticizeremployed is not critical and preferred plasticizers includedioctylphthalate and C₂-C₄-acyl tri-n-hexyl citrates.

Optionally as well, the cyanoacrylate composition applied by the presentapplicator can include an “antimicrobial agent”. As used herein, theterm “antimicrobial agent” refers to agents which destroy microbes(i.e., bacteria, fungi, yeasts, prions and viruses) thereby preventingtheir development and their pathogenic action. In preferred embodiments,the cyanoacrylate composition may contain from about 0.01 to about 5weight-percent antimicrobial.

Preferred cyanoacrylate compositions useful in the practice of thisinvention are also disclosed in U.S. Pat. No. 5,480,935, whichapplication is incorporated herein by reference in its entirety. In aparticularly preferred embodiment, the cyanoacrylate adhesivecomposition further comprises an antimicrobially effective amount of acompatible antimicrobial agent. Such compositions preferably comprisefrom about 0.1 to about 40 and preferably 1 to 30, or more preferably 5to 20 weight percent of the compatible antimicrobial agent either as asolution or as a suspension based on the total weight of thecomposition. Compatible antimicrobial agents are those which are eithersoluble or suspendable in the cyanoacrylate composition, which do notcause premature polymerization of the cyanoacrylate composition, whichdo not prevent polymerization of the cyanoacrylate composition whenapplied to mammalian skin, and which are compatible with the intendeduse including biocompatibility with the patient's skin. Suitable suchcompositions are disclosed in U.S. Pat. No. 5,762,919 which isincorporated herein by reference in its entirety.

In a particularly preferred embodiment, the compatible antimicrobialagent comprises a complex of iodine molecules with a biocompatiblepolymer. Such complexes are well known in the art and the resultingcomplex typically comprises both available iodine and iodide anions.These complexes, on contact with mammalian skin, provide for a source ofantimicrobial iodine. In any event, such complexes are employed only asstarting materials herein and, by themselves, do not form a part of thisinvention. Suitable biocompatible polymers include, by way of exampleonly, polyvinylpyrrolidone polymer which, when complexed with iodine, isalso referred to under the common name of povidone-iodine available fromBASF, Mt. Olive, N.J., USA. When povidone-iodine is employed in thecyanoacrylate composition, it is preferably from about 5 to about 40weight percent and more preferably from about 10 to about 25 weightpercent is added to the cyanoacrylate composition based on the totalweight of the composition.

Other suitable antimicrobial agents include complexes of iodinemolecules with copolymers of vinylpyrrolidone and vinyl acetate,copolymers of vinylpyrrolidone and vinyl acetate cross-linked withpolyisocyanates, copolymers of vinylpyrrolidone and vinylfunctionalities, polymers of pyrrolidone and the like.

The use of a compatible antimicrobial agent in the composition permitsthe agent to be released from the polymeric film thereby reducingmicrobial growth under the film.

Other medicaments suitable for use in conjunction with the cyanoacrylatecomposition include corticoid steroids such as described by Greff, etal. in U.S. Pat. No. 5,962,010 which is incorporated herein by referencein its entirety and analgesic compounds such as lidocaine. The formerreduces inflammation at the site of the application whereas the latterreduces pain. Combinations of a steroid with an analgesic are alsocovered.

Although only preferred embodiments of the invention are specificallydisclosed and described above, it will be appreciated that manymodifications and variations of the present invention are possible inlight of the above teachings and within the purview of the appendedclaims without departing from the spirit and intended scope of theinvention.

What is claimed is:
 1. An applicator for controllably releasing andapplying a surgical adhesive to an incision comprising a receiver havinga deformable cylindrical body, the body having a deformable cylindricalwall and a cylinder-closing first end and an open second end, theinternal dimensions of the receiver being set to accommodate and receivea sealed ampoule of surgical adhesive, the ampoule being formed of afrangible material which when fractured releases the surgical adhesive,the second open end being cylindrical with a series of circumferentialsealing ribs present on the outer surface of the second open end, ablunt cylindrical body of a surgical adhesive-permeable foam materialinserted into the open second end of the receiver to absorb and transmitadhesive released from the ampoule, a cylindrical collar having an openfirst end and an open second end, the first end of the collar having aninternal diameter selected to sealably engage the circumferentialsealing ribs, the collar enclosing the body of foam material, and thesecond end of the collar having an internal diameter selected to providea narrowed pathway for the released adhesive to pass when the collar issealed to the second end of the receiver.
 2. The applicator of claim 1further comprising a latching slot in the outer surface of the secondend of the receiver, the latching slot located adjacent to thecircumferential sealing ribs but being between the circumferentialsealing ribs and the first end, and the collar having aninternally-projecting locking key which fits into the locking slot andlocks the collar onto the receiver when the collar is rotated on acommon axis between the collar and the receiver.
 3. The applicator ofclaim 1 further comprising a flow restrictor frictionally attached tothe second end of the collar through which surgical adhesive can pass.4. The applicator of claim 3 wherein the flow restrictor is a pipettetip
 5. The applicator of claim 1 further comprising at least onepressure barb positioned to apply an ampoule-fracturing force to thesealed ampoule.
 6. The applicator of claim 5 further comprising at leastone pressure pad positioned to apply an adhesive-expressing pressure tothe fractured ampoule.
 7. The applicator of claim 1 further comprising apair of wings, each having an inside and an outside end with the insideend affixed to the receiver at a position adjacent to the open end withthe two wings being positioned diametrically across the cylindricalbody, with the outside end of the wings being splayed out away from thecylindrical wall but being movable toward the cylindrical wall when auser applies opposing-finger pressure to the outside ends, each of thewings having a pressure barb facing toward the cylindrical wall, thepressure barb bearing upon the cylindrical wall and capable of applyinga compressing force to the cylindrical wall, which compressing forcedistorts the cylindrical wall of the cylindrical body and applies afracturing force to an ampoule accommodated and received within thereceiver, the fracturing force releasing surgical adhesive containedwithin the ampoule.
 8. The applicator of claim 7 wherein each of thewings additionally comprises a pressure pad facing toward thecylindrical wall, the pressure pad bearing upon the cylindrical wall andcapable of applying an adhesive-expressing compressing force to thecylindrical wall, which adhesive-expressing compressing force distortsthe cylindrical wall of the cylindrical body and applies an adhesiveexpressing force to the ampoule, the adhesive-expressing forceexpressing surgical adhesive contained within the ampoule out of theapplicator.
 9. An applicator for controllably releasing and applying asurgical adhesive to an incision comprising a receiver having adeformable cylindrical body, the body having a deformable cylindricalwall and a cylinder-closing first end and an open second end, theinternal dimensions of the receiver being set to accommodate and receivea sealed ampoule of surgical adhesive, the ampoule being formed of afrangible material, the second open end being cylindrical with a seriesof circumferential sealing ribs present on the outer surface of thesecond open end and a latching slot in the outer surface of the secondend, the latching slot located adjacent to the circumferential sealingribs but being between the circumferential sealing ribs and the firstend, a pair of wings, each having an inside and an outside end with theinside end affixed to the receiver at a position adjacent to the openend with the two wings being positioned diametrically across thecylindrical body, with the outside end of the wings being splayed outaway from the cylindrical wall but being movable toward the cylindricalwall when a user applies opposing finger pressure to the outside ends,each of the wings having a pressure barb facing toward the cylindricalwall, the pressure barb bearing upon the cylindrical wall and capable ofapplying a compressing force to the cylindrical wall, which compressingforce distorts the cylindrical wall of the cylindrical body and appliesa fracturing force to an ampoule accommodated and received within thereceiver, the fracturing force releasing surgical adhesive containedwithin the ampoule, a blunt cylindrical body of surgicaladhesive-permeable foam inserted into the open second end of thereceiver to absorb and transmit adhesive released from the ampoule, acylindrical collar having an open first end and an open second end, thefirst end having an internal diameter selected to sealably engage thecircumferential sealing ribs and having an internally-projecting lockingkey which fits into the locking slot and locks the collar onto thereceiver when the collar is rotated on a common axis between the collarand the receiver, the collar enclosing the body of foam, and the secondend having an internal diameter selected to provide a narrowed pathwayfor the adhesive to pass when the collar is sealed to the second end ofthe receiver, and the second end of the collar having a slightly taperedcylindrical shape sized to frictionally and sealably engage a pipettetip the pipette tip, when sealed to the collar providing a sealed narrowpathway for surgical adhesive to pass from the receiver through thepipette tip and the collar, when removed, providing a broader pathwayfor the adhesive to pass as a sealing layer from the receiver throughthe body of foam to the incision.
 10. The applicator according to claim1, wherein the surgical adhesive comprises a cyanoacrylate ester, inmonomeric form, represented formula I:

where R is selected from the group consisting of: alkyl of 1 to 10carbon atoms, alkenyl of 2 to 10 carbon atoms, cycloalkyl groups of from5 to 8 carbon atoms, phenyl, 2-ethoxyethyl, 3-methoxybutyl, and asubstituent of the formula:

wherein each R′ is independently selected from the group consisting of:hydrogen and methyl, and R″ is selected from the group consisting of:alkyl of from 1 to 6 carbon atoms, alkenyl of from 2 to 6 carbon atoms,alkynyl of from 2 to 6 carbon atoms, cycloalkyl of from 3 to 8 carbonatoms, aralkyl selected from the group consisting of benzyl,methylbenzyl and phenylethyl, phenyl, and phenyl substituted with 1 to 3substituents selected from the group consisting of hydroxy, chloro,bromo, nitro, of alkyl 1 to 4 carbon atoms, and alkoxy of from 1 to 4carbon atoms.
 11. The applicator of claim 10, wherein the surgicaladhesive further comprises an antimicrobial agent.
 12. A method ofclosing and sealing an incision with an adhesive applicator comprisingobtaining the applicator of claim 9 with the sealed ampoule of surgicaladhesive contained in the receiver, applying a squeezing-togetherpressure to the wings to produce a compressing force to the cylindricalwall, which compressing force distorts the cylindrical wall of thecylindrical body and applies a fracturing force to the ampoule, thefracturing force releasing the surgical adhesive contained within theampoule, the adhesive passing through the adhesive-permeable foamthrough the cylindrical collar and through the pipette tip to form thesmall drops of adhesive, closing the incision by applying the smalldrops of adhesive from the applicator to the incision; removing thepipette tip to provide a tip-free applicator, sealing the incision byapplying a line of adhesive from the tip-free applicator to the incisionthrough the body of adhesive-permeable foam.
 13. The method of claim 12,wherein the incision is a incision made during laparoscopic surgery. 14.The method of claim 12, wherein the surgical adhesive comprises acyanoacrylate ester, in monomeric form, represented formula I:

where R is selected from the group consisting of: alkyl of 1 to 10carbon atoms, alkenyl of 2 to 10 carbon atoms, cycloalkyl groups of from5 to 8 carbon atoms, phenyl, 2-ethoxyethyl, 3-methoxybutyl, and asubstituent of the formula:

wherein each R′ is independently selected from the group consisting of:hydrogen and methyl, and R″ is selected from the group consisting of:alkyl of from 1 to 6 carbon atoms, alkenyl of from 2 to 6 carbon atoms,alkynyl of from 2 to 6 carbon atoms, cycloalkyl of from 3 to 8 carbonatoms, aralkyl selected from the group consisting of benzyl,methylbenzyl and phenylethyl, phenyl, and phenyl substituted with 1 to 3substituents selected from the group consisting of hydroxy, chloro,bromo, nitro, of alkyl 1 to 4 carbon atoms, and alkoxy of from 1 to 4carbon atoms.
 15. The applicator of claim 12, wherein the surgicaladhesive further comprises an antimicrobial agent.